Opioids

A pilot program led by the Connecticut Poison Control Center and UConn Health’s Emergency Medicine department has been tracking opioid overdoses in Hartford in real time to improve surveillance of the opioid epidemic. More than 1,000 people died from opioid overdoses in Connecticut in 2017, including 80 in Hartford.

The project, launched May 1, has emergency medical service (EMS) personnel in Hartford report overdose cases to the state’s Poison Control Center, part of UConn’s Emergency Medicine department, immediately after the incident. The Center’s poison information specialists ask the emergency responders a series of brief questions and record the data.

The test program is a collaboration with American Medical Response (AMR) ambulances, which provide coverage to two-thirds of Hartford’s communities, and nearby Saint Francis Hospital and Medical Center’s emergency department.

“This new program is increasing our awareness of what is happening on the ground,” says Peter Canning, UConn John Dempsey Hospital’s EMS coordinator.

UConn Health hopes the program establishes an effective early warning system to alert public health and safety officials and community stakeholders of any sudden spike in overdoses or the potential threat of a potent batch of opioid drugs released in certain neighborhoods.

Since the program began in May, the AMR ambulance crews in Hartford reported 211 overdose cases to the Connecticut Poison Control Center. In 147 of the reported cases, emergency crews had to administer the opioid antidote naloxone to revive the overdose victims.

Early data attributes 98 percent of the overdoses where the substance was known to heroin and fentanyl, and 2 percent to other opioids such as oxycodone and methadone. The majority of victims — 77 percent — were male, 51 percent of whom were between the ages of 35 and 49. In addition, 67 percent of the overdoses occurred in public areas such as city parks, roadways, sidewalks, and restrooms. EMS also reported cases of victims who thought they bought cocaine, but instead overdosed on powdered heroin.

This fall the pilot program may expand to include Aetna Ambulance Service in the south end of Hartford.​

“This new program is an important step forward and a great example of multi-agency collaboration,” says Dr. Suzanne Doyon, Connecticut Poison Control Center medical director. “Rapid real-time identification of potentially troubled areas of the state is important to public health. Using the connectivity and round-the-clock expertise of the Poison Control Center is both novel and forward-thinking.

“We hope this becomes the model for reporting statewide. The ultimate goal here is to reduce overdoses and save lives.”

An estimated 100 million Americans suffer from chronic pain — more than those affected by heart disease, cancer, and diabetes combined, according to The National Academies of Science, Engineering, and Medicine. How best to manage that pain in the face of a nationwide opioid crisis is the question on many practitioners’ minds.

The Connecticut Pain Consortium — a translational pain research and education collaboration between UConn Health, the UConn schools of Medicine and Nursing, and The Jackson Laboratory — aims to help answer it.

Given the broad range of research interests and funding opportunities related to pain, the founders envision that centers across the University and nearly every UConn school and college — particularly the schools of Dental Medicine and Pharmacy — will join the consortium to build mutually beneficial collaborations. Experts from Yale University and hospitals including Connecticut Children’s Medical Center will also be involved.

“There is a clear need for more basic and translational research on human pain and pain management,” says the Consortium’s director, mathematician and computational biologist Reinhard Laubenbacher, a joint faculty member at UConn Health and The Jackson Laboratory for Genomic Medicine.

“And there is a critical unmet need for education and training of providers and patients. This is a great opportunity to deploy our capabilities in pain research and addiction together with our Connecticut partners in an exciting and much-needed statewide initiative.”

The Consortium, the first of its kind in the Connecticut medical community, will establish a portal for pain-related health care data and facilitate research collaborations that leverage state and national resources. It will aim to translate that research into cutting-edge pain management solutions and raise awareness of the many facets of pain, pain management, and potential related ramifications including opioid addiction. The Consortium will contribute to a curriculum on pain research and management for health care providers.

The launch is being funded by a $55,000 planning grant from the Mayday Fund, whose mission is to support projects that close the gap between knowledge and practice in the treatment of pain, to the UConn Foundation. The Consortium has also received support from the UConn Office of the Vice President for Research, the schools of Nursing and Medicine, and the Jackson Laboratory for Genomic Medicine.

“This new consortium builds upon strengths already existing in the School of Medicine, with an existing core of faculty focused on pain research,” says Dr. Bruce T. Liang, dean of the School. “Thanks to this grant, we believe there will be numerous opportunities for advancement in the study and treatment of pain.”

Opioid prescriptions for chronic pain have quadrupled since 1999, and in that time, more than 165,000 lives in the U.S. have been lost to opioid overdose. UConn Health Journal sat down with Dr. Surita Rao to set the record straight on what medical providers need to know about properly prescribing pain pills.

Dr. Surita Rao is on the board of directors of the American Society of Addiction Medicine and past president of its Connecticut chapter.

Opioid prescriptions for chronic pain have quadrupled since 1999, and in that time, more than 165,000 lives in the U.S. have been lost to opioid overdose. UConn Health Journal sat down with Dr. Surita Rao to set the record straight on what medical providers need to know about properly prescribing pain pills.

Dr. Surita Rao is on the board of directors of the American Society of Addiction Medicine and past president of its Connecticut chapter.

Q

Can you characterize the U.S. opioid epidemic?

Our country’s opioid epidemic has been going on for several years. The U.S. is the biggest global consumer of prescription opioids. In 1997, 76 million prescriptions were written, more than doubling by 2013 to 207 million. Americans consume nearly 100 percent of the world’s hydrocodone (Vicodin) and 81 percent of its oxycodone. The majority of those physically addicted or overdosing are getting opioid prescriptions from their doctors’ offices.

Q

What are the dangers of opioids?

These strong pain pills are very physically addictive and it’s often hard for patients to live without them, even after their pain subsides. The biggest dangers of opioids are overdose and death. After doctors stop prescribing them, some patients turn to the street to illegally get their pills, while some may even switch to heroin. When mixed with heroin, anxiety medications, or alcohol, opioids are even more likely to lead to overdose.

Q

What do the new Centers for Disease Control and Prevention guidelines call for?

In March the CDC called on primary care doctors to more carefully assess each individual patient’s risk of taking an opioid and to take extreme caution when prescribing it for longer than seven days for acute pain, unless for terminal cancer or palliative care. The lowest-effective dose of non-slow-release pain pills should always be used, and patient use needs to be continuously reevaluated. Guidelines stress the critical need for increased education and communication about opioid risks including constipation, drowsiness, stopping breathing, drug and alcohol interaction, addiction, overdose, and death.

Q

What should medical providers keep top-of-mind?

For patients, physicians should always consider first NSAIDS (such as acetaminophen and ibuprofen), routine exercise, physical therapy, hot and cold compresses, and possibly steroidal injections. If opioids are necessary, beware that long-term opioid use can lead to physical dependence and intense withdrawal. Patients should be slowly weaned off. Patients who have developed an addiction to opioids that goes beyond a physical dependence will need to undergo medical detox, or take agonist maintenance medication to curb their brain-receptor cravings. Psychotherapy specifically targeted for substance abuse disorders, including individual counseling and group therapy, is always needed for successful recovery from an addictive illness. Patients should be encouraged to proactively lower their daily pain risk factors, not abuse or share opioids, and seek medical attention if they start to experience withdrawal symptoms or addiction.